Physical activity in gestational trimesters and perinatal outcomes in SUS puerperal women

ABSTRACT OBJECTIVE Test the association between the practice of physical activity (PA) according to the gestational trimesters and the occurrence of cesarean delivery, prematurity, and low birth weight in puerperal women assisted in the Unified Health System of Santa Catarina, Brazil. METHODS A cross-sectional study was conducted with a probabilistic sample of puerperal women who gave birth in public maternity hospitals in Santa Catarina from January to August 2019. The cesarean delivery outcome was self-reported, and information on premature birth (< 37 gestational weeks) and low birth weight (< 2,500 grams) were obtained from medical records. The practice of PA during pregnancy and according to each trimester was self-reported. Multivariate Logistic Regression analyses and interviews with 3,580 puerperal women were carried out. RESULTS PA practice during any period of pregnancy was reported by 20.6% of the sample, with a gradual reduction in prevalence according to the gestational trimester (16.2%, 15.4%, and 12.8%). The highest prevalences of outcomes concerning the total sample were observed in puerperal women who did not practice PA in the third trimester, with 43.9% for cesarean delivery, 7.7% for low birth weight, and 5.5% for premature birth. The odds of cesarean delivery (OR = 1.40; 95%CI 1.10–1.76) and low birth weight (OR = 1.99; 95%CI 1.04–3.79) were, respectively, 40% and 99% higher among puerperal women who did not practice PA in the third trimester of pregnancy when compared to those who practiced PA. There was no association between PA practice and prematurity. CONCLUSION Puerperal women who did not practice PA in the third trimester of pregnancy were more likely to have cesarean delivery and low birth weight newborns.

摘要
【研究目的】 旨在探究巴西圣卡塔琳娜州统一卫生系统（Unified Health System）服务的产褥期妇女（puerperal women）中，按妊娠三月期（gestational trimester）划分的身体活动（physical activity, PA）参与情况，与剖宫产（cesarean delivery）、早产（prematurity）及低出生体重（low birth weight）发生风险的关联。
【研究方法】 本研究为横断面研究（cross-sectional study），纳入2019年1月至8月间于圣卡塔琳娜州公立助产医院分娩的产褥期妇女概率抽样样本（probabilistic sample）。剖宫产结局通过自我报告方式获取；早产（妊娠孕周<37周）与低出生体重（出生体重<2500克）的信息提取自病历档案。妊娠期间及各妊娠三月期的身体活动参与情况均由研究对象自我报告。本研究共访谈3580名产褥期妇女，并开展多因素Logistic回归（Multivariate Logistic Regression）分析。
【研究结果】 样本中有20.6%的产褥期妇女报告在妊娠任一阶段参与了身体活动，且该参与率随妊娠三月期推进呈逐步下降趋势：第一妊娠三月期为16.2%，第二为15.4%，第三为12.8%。在未参与第三妊娠三月期身体活动的产褥期妇女中，全样本各项不良结局的患病率均处于最高水平：剖宫产占比43.9%，低出生体重占比7.7%，早产占比5.5%。与妊娠第三三月期参与身体活动的产褥期妇女相比，未在此阶段参与身体活动者发生剖宫产（OR=1.40；95%CI=1.10~1.76）与低出生体重（OR=1.99；95%CI=1.04~3.79）的风险分别升高40%与99%。未发现身体活动参与情况与早产存在统计学关联。
【研究结论】 未于妊娠第三三月期参与身体活动的产褥期妇女，其发生剖宫产及诞下低出生体重新生儿的风险更高。